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QMS: 601/2566/4 Specification

Page 1 of 25 IQB/0.2/214 | Version 4.0 | 19/12/2017 | Author DM © Industry Qualifications 2017

IQ Level 3 Award in Awareness of End of Life Care

Specification

Regulation No: 601/2566/4



Contents Page About Industry Qualifications (IQ) ....................................................................................................................................... 3 The IQ Group ...................................................................................................................................................................... 3 Contact Us .......................................................................................................................................................................... 3 Introduction ......................................................................................................................................................................... 3 Version Number .................................................................................................................................................................. 3 About this Qualification ....................................................................................................................................................... 4 Objective ............................................................................................................................................................................. 4 Purpose ............................................................................................................................................................................... 4 Sector .................................................................................................................................................................................. 4 Structure.............................................................................................................................................................................. 4 Delivery ............................................................................................................................................................................... 4 Assessment ......................................................................................................................................................................... 5 Age range and Geographical Coverage .............................................................................................................................. 5 Learner entry requirements ................................................................................................................................................. 5 Tutor requirements .............................................................................................................................................................. 5 Centre Requirements .......................................................................................................................................................... 5 Centres must be approved by IQ in order to offer this qualification. .................................................................................... 5 Unit 1: Understand how to work in end of life care A/503/8085 ....................................................................................... 6 Unit 1 Guidance on Delivery and Assessment .................................................................................................................. 11 Unit 2: Understand how to provide support when working in end of life care Y/503/8689............................................... 12 Unit 2 Guidance on Delivery and Assessment .................................................................................................................. 17 Unit 3: Understand how to support individuals during the last days of life J/503/8137 ...................................................... 18 Unit 3 Guidance on Delivery and Assessment .................................................................................................................. 22 Appendix A ........................................................................................................................................................................ 23 Resources ......................................................................................................................................................................... 25



About Industry Qualifications (IQ) Industry Qualifications’ (IQ) founding principle is to provide qualifications that are responsive to the needs of the vocational sector to ensure that learners are provided with a learning experience relevant to their industry. We aim to provide qualifications that are valued and recognised as being best in class by ensuring the highest levels of assessment integrity and customer service. We are approved by UK’s regulators of qualifications: Ofqual, CCEA, Qualification Wales and SQA Accreditation. The IQ Group IQ Group of Companies seek to provide an internationally recognised mark of quality assurance for skills, management systems, products and services. IQ promotes quality, partnership and integrity through its group of companies spanning education, professional membership and standards certification markets. Our focus is on high growth, highly specialised sectors with potential for international growth. Contact Us We are here to help if you need further guidance from us. The IQ customer service team can be contacted between 9am and 5pm Monday to Friday at: Email: [email protected] Main Phone Switchboard: +44 (0) 1952 457 452 Fax: +44 (0) 843 211 1067 Head Office Address: Coppice House Halesfield 7 Telford Shropshire TF7 4NA For guidance on any fees we charge for the services we provide, please see the IQ Price Guide: www.industryqualifications.org.uk/centre-portal/iq-price-guide

Introduction This specification is intended for trainers, centres and learners. General information regarding centre approval, registration, IQR (IQ’s candidate management system), assessment papers, certification, reasonable adjustments, special consideration, appeals procedures, are available from the website. This document should be read in conjunction with the IQ QMS Centre guide available from the website. Website: www.industryqualifications.org.uk Enquiries: 01952 457452

Version Number Please ensure that you have the latest and most up to date version of documents. Please check the website for the most up to date version. To check which version you have please see the footer which will give you the version number V3.0 updated February 2017: All pages re-formatted, updates to pages 3, 4 and 5

V4 updated December 2017: QCF removed. TQT column added. Total Unit Time per section added.

http://www.industryqualifications.org.uk/centre-portal/iq-price-guide

http://www.industryqualifications.com/



About this Qualification

The IQ Level 3 Award in Awareness of End of Life Care aims to develop learners' knowledge of end of life care in a vocational setting. It is applicable to learners whose job role includes caring for individuals with a life-limiting illness. The qualification addresses definitions of end of life care, common questions, approaches to care, how to support familial, spiritual, social and emotional needs, and prepares learners to deal with death and bereavement. Objective Supporting a role in the workplace Purpose B Prepare for further learning or training and/or develop knowledge and/or skills in a subject area B2. Develop knowledge and/or skills in a subject area Sector 1.3 Health & Social Care Structure To achieve this qualification learners have to achieve 10 credits from three mandatory units

Unit Unit number Level Credit Guided Learning Hours

Estimated TQT*

Understand how to work in end of life care

A/503/8085 2 3 28 30

Understand how to provide support when working in end of life care

Y/503/8689 3 4 33 40

Understand how to support individuals during the last days of life

J/503/8137 3 3 28 30

Total 10 89 100

Delivery Estimated Total Qualification Time (TQT)* This is an estimate of the total length of time it is expected that a learner will typically take to achieve and demonstrate the level of attainment necessary for the award of the qualification i.e. to achieve all learning outcomes. TQT is comprised of Guided Learning Hours (GLH) and an estimate of the number of hours a learner is likely to spend in preparation, study or any other learning including assessment, which takes place as directed by, but not under the supervision of a lecturer, supervisor or tutor. If a credit value is assigned to a qualification it is determined by TQT, as one credit corresponds to 10 hours of learning. Guided learning hours are 89. It is the responsibility of training centres to decide the appropriate course duration, based on their learners’ ability and level of existing knowledge. It is possible, therefore, that the number of Guided Learning Hours can vary from one training centre to another according to learners' needs. Guided learning hours are all times when a member of provider staff is present to give specific guidance towards the learning aim being studied on the programme. This definition includes lectures, tutorials, and supervised study. It does not include hours where supervision or assistance is of a general nature and is not specific to the study of the learners.



Assessment This qualification is not graded, successful learners achieve a pass. All the units in this qualification are knowledge-based. Assessment is by portfolio (internally set and marked and quality assured by IQ) which must meet the requirements of the Skills for Care and Development QCF Assessment Principles (Appendix A located at the end of this document). Further guidance for each unit can be found in the assessment guidance relevant to each unit. All Assessment Criteria must be met in each relevant unit to achieve this qualification. All Assessment criteria of selected units must be met. An Achievement Record for this qualification is available from the website/ on request. All assessment criteria must be met and mapped and the location of the evidence must be indicated in the achievement record. All learning outcomes in this qualification must be assessed using methods appropriate to the assessment of knowledge and understanding; these can be assessed by a variety of methods including:

Question and answer test

Multiple choice questions

Question and answer verbal (ensure records are kept)

Essay

Other Age range and Geographical Coverage This qualification is approved for learners 16 plus in England and Northern Ireland. Learner entry requirements There are no formal entry requirements. However, learners should be able to work at level 2 or above. Progression

Learners can progress to a range of health and Social Care qualifications such as:

IQ Level 3 Diploma in Health & Social Care (Adults) for England (QCF)

IQ Level 3 Certificate in Preparing to Work in Adult Social Care (QCF)

IQ Level 2 Award in Employment Rights and Responsibilities in Health, Social Care or Children and Young People's Settings (QCF)

Level 3 Diploma in Clinical Healthcare Support

Level 3 Diploma in Healthcare Support Services

IQ Level 2 Award in Awareness of Dementia (QCF)

Level 2 Certificate in the Principles of Dementia Care (QCF)

Level 3 Award in Awareness of Dementia (QCF)

IQ Level 2 Certificate in Understanding the Safe Handling of Medicines (QCF)

Level 2 Certificate in Understanding Working in Mental Health (QCF)

Level 3 Certificate in the Principles of End of Life Care (QCF)

Tutor requirements All trainers delivering this qualification must have

Appropriate teaching qualification e.g. PTLLS , Level 3 Award in Education and Training (QCF)

Subject knowledge Centre Requirements Centres must be approved by IQ in order to offer this qualification.



Unit 1: Understand how to work in end of life care A/503/8085 Guided Learning Hours: 28 Unit Level: 2

Unit credit 3 Total Unit Time: 30

Unit grid: Learning outcomes/Assessment Criteria/Content

Learning Outcome - The learner will: Assessment Criteria - The learner can: Indicative Contents:

1. Know different perspectives on death and dying.

1.1 Outline the factors that can affect an individual’s views on death and dying.

Factors that can affect an individual’s views on death and dying: To include:

Cultural

Emotional

Past experience

Psychological

Religious

Social

Spiritual

1.2 Outline the factors that can affect own views on death and dying.

Factors that can affect own views on death and dying: To include:

Cultural

Emotional

Past experience

Psychological

Religious

Social

Spiritual

1.3 Outline how the factors relating to views on death and dying can impact on practice.

How the factors relating to views on death and dying can impact on practice: To include: Current and previous professional roles and responsibilities and past; boundaries limited by legal and ethical issues; professional codes of practice - internal and national; impact of management and leadership; input from other team members and workers.

1.4 Define how attitudes of others may influence an individual’s How attitudes of others may influence an individual’s choices around



choices around death and dying. death and dying : To include: different models of nursing care; person-

centred approaches; approaches and application of theories of change, loss and bereavement Others may include:

Advocates

Care worker

Clinical nurse specialists

Colleague

Community psychiatric nurse

Doctors

Family

Friends

Manager

Occupational therapist

Pharmacist

Physiotherapist

Social worker

Speech and language therapist

2. Understand the aims, principles and policies of end of life care.

2.1 Explain the aims and principles of end of life care. The aims and principles of end of life care: To include: reducing inappropriate or burdensome healthcare interventions; offering choices of place of care; maintaining comfort choices; supporting individuality; meeting psychological and spiritual needs of individual and families; support for families continuing into bereavement; common goals of care identified by patients as they approach the end of life are: to be cured; to live longer; to improve or maintain functionality / quality of life / independence; to be comfortable; to achieve life goals; and support for family / caregiver.

2.2 Explain why it is important to support an individual in a way that promotes their dignity.

Why it is important to support an individual in a way that promotes their dignity: To include: Shared decision-making between clinicians and patients and their families; to ensure that: patient’s needs, wishes and preferences are addressed; information about a patient’s changing condition is disclosed by clinicians or family. Central part of end-of-life care: is supporting patients’ and families’ acceptance of the inevitability of death; Spiritual care; cultural differences are identified and appropriately addressed.



2.3 Describe the importance of maintaining comfort and well-being in end of life care.

Importance of maintaining comfort and well-being in end of life care: To include:

Pain and symptom management Preparation for the end of life Relationships between patients, family members and healthcare

providers Achieving a sense of completion

2.4 Explain the stages of the local end of life care pathway. Stages of the local end of life care pathway: To include: End of Life Care Strategy (DH 2008)

Step 1 - Discussions as the end of life approaches

Step 2 - Assessment, care planning and review

Step 3 - Co-ordination of care

Step 4 - Delivery of high quality services in different settings

Step 5 - Care in the last days of life

Step 6 - Care after death

2.5 Describe the principles of advance care planning. Principles of advance care planning: To include: encourage people to consider, discuss, and document their future wishes for care; discussing treatment preferences with the patient; the range of assessment tools, ways of gathering information; assessment of pain and other symptoms, pain history, appropriate physical examination and relevant investigation; multi-disciplinary assessment and information sharing; holistic assessments including:

Background information

Current physical health and prognosis

Social/occupational well-being

Psychological and emotional well-being

Religion and/or spiritual well-being, where appropriate

Culture and lifestyle aspirations, goals and priorities

Risk and risk management

The needs of families and friends, including carer’s assessments;

take account of changing needs, priorities and wishes, and ensure information about changes is properly communicated; awareness and understanding of Advance Care Planning, and the times at which it would be appropriate; awareness and understanding of the legal status

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086277


http://www.endoflifecare.nhs.uk/care-pathway/step-1-discussions-as-the-end-of-life-approaches.aspx

http://www.endoflifecare.nhs.uk/care-pathway/step-2-assessment,-care-planning-and-review.aspx

http://www.endoflifecare.nhs.uk/care-pathway/step-3-co-ordination-of-care.aspx

http://www.endoflifecare.nhs.uk/care-pathway/step-4-delivery-of-high-quality-services-in-different-settings.aspx

http://www.endoflifecare.nhs.uk/care-pathway/step-5-care-in-the-last-days-of-life.aspx

http://www.endoflifecare.nhs.uk/care-pathway/step-6-care-after-death.aspx



and implications of the Advance Care Planning process in accordance with the provisions of the Mental Capacity Act 2005; understanding of Informed Consent; effective communication skills; working sensitively with families and friends to support them as the individual decides upon their preferences and wishes ; ensure that the wishes of the individual are shared (with permission) with other workers.

2.6 Define local and national policy and guidance for care after death.

Local and national policy and guidance for care after death: To include: National End of Life Care Programme; end of life care Quality Standard ; When a Patient Dies 2005; Standards for bereavement care in the UK revised by Cruse Bereavement Care and the Bereavement Services Association; new regulations on death certification process.

3. Understand factors regarding communication in end of life care.

3.1 Explain how an individual’s priorities and the ability to communicate may vary over time.

How an individual’s priorities and the ability to communicate may vary over time: To include: change from long term treatment and management of symptom to short term treatment; recognition and acceptance of imminent death; concerns for family and friends; planning for what they want to happen, funeral arrangements; reduced ability to communicate and express views and concerns; extra difficulty communicating for e.g., those with dementia, learning or sensory disabilities; support for carers and family members including children, recognising the impact of bereavement upon them; timely identification of the last days of life, individualised care to their needs and preferences.

3.2 Explain your role in responding to key questions and cues from individuals and others regarding their end of life experience.

Responding to key questions and cues from individuals and others regarding their end of life experience: To include: sensitivity to cultural, religious and other beliefs and customs; effective, straightforward, and open communication with individuals, families, friends and workers; information is clear, and free from jargon.

3.3 Describe how you might respond to difficult questions from individuals and others.

How you might respond to difficult questions from individuals and others: To include: straightforward language, clear information; careful use of medical terms and abbreviations; showing sensitivity and awareness of individual circumstances; referring to others for advice on appropriate response when question is outside of own area of expertise

3.4 Outline strategies to manage emotional responses from individuals and others.

Strategies to manage emotional responses from individuals and others: To include: professional approach; prepare for the interaction; request support from colleague if appropriate; allow plenty of time; recognise



own responses; focussed on individual and others

3.5 Explain the importance of sharing appropriate information according to the principles and local policy on confidentiality and data protection.

Importance of sharing appropriate information according to the principles and local policy on confidentiality and data protection: To include: know what information can be shared and with whom; confirm with senior staff if unsure; follow given guidelines.

4. Know how to access the range of support services available to individuals and others.

4.1 Identify the range of support services and facilities available to an individual and others.

Support services and facilities available to an individual and others: To include:

Pastoral services

Other professionals

Citizens advice

Self-help organisations

Hospices

4.2 Identify the key people who may be involved within a multi-disciplinary end of life care team.

Key people who may be involved within a multi-disciplinary end of life care team: To include: GP practices, occupational therapists, physiotherapists , other health professionals, care homes, pharmacies, hospices, ambulance services, local hospitals, local authority and voluntary sector support services.

4.3 Identify the potential barriers an individual may face when accessing end of life care.

Potential barriers an individual may face when accessing end of life care: To include: institutional barriers e.g. Policies that prohibit families from freely visiting dying patients, absence of pain and symptom management services, absence of policies that promote adequate assessment and reporting; regulations e.g. institutional, local , regional, national; limits on the prescription of appropriate analgesics, fear of prosecution of physicians for prescribing medications aimed at the relief of pain and symptoms; financial constraints; individual attitudes e.g. patients, families, and professionals who feel there is "nothing more to do" for a patient who has a life-threatening prognosis; societal tendency to shun the dying and deny attention to the suffering

4.4 Suggest ways to minimise the barriers an individual may face when accessing end of life care.

Ways to minimise the barriers an individual may face when accessing end of life care: To include: addressing and challenging barriers; challenging attitudes; promoting good practice; provision of training



Unit 1 Guidance on Delivery and Assessment

Delivery This unit develops the learner’s knowledge and understanding of different perspectives on death and dying, the aims, principles and policies of end of life care, communication in end of life care and how to access the range of support services available to individuals and others. Assessment Assessment is by portfolio (internally set and marked and quality assured by IQ). An Achievement Record for this qualification is available from the website/ on request. All assessment criteria must be met and mapped and the location of the evidence must be indicated in the achievement record. All learning outcomes must be assessed using methods appropriate to the assessment of knowledge and understanding; these can be assessed by a variety of methods including:




Essay

Other. This unit must be assessed in accordance with Skills for Care and Development’s Assessment Principles (located in Appendix A of the specification for this qualification).

Links The unit links to Skills for Care and Skills for Health Common Core Competences and Principles for End of Life Care



Unit 2: Understand how to provide support when working in end of life care Y/503/8689 Guided Learning Hours: Unit Level: Unit Credit: Total Unit Time:

33 3 4

40



1. Understand current approaches to end of life care

1.1 Analyse the impact of national and local drivers on current approaches to end of life care

Impact of national and local drivers on current approaches to end of life care: To include: Common core competences and principles for health and social care workers working with adults at the end of life, published in 2009 by Skills for Care, Skills for Health, the National End of Life Care Programme and the Department of Health Developing end of life care practice - guidance developed by Skills for Business, National End of Life care programme, Skills for Health, Skills for Care Department of Health end of life care strategy Department of Health’s Quality Innovation Productivity and Prevention (QIPP) national priorities Palliative Care Funding Review (PCFR)

1.2 Evaluate how a range of tools for end of life care can support the individual and others

Range of tools for end of life care: To include:

Liverpool Care Pathway

Gold Standards Framework or equivalent

Preferred priorities of care

Advance care plan approaches

Welsh integrated care pathway

1.3 Analyse the stages of the local end of life care pathway

Stages of the local end of life care pathway: To include: End of Life Care Strategy (DH 2008)

Step 1 - Discussions as the end of life approaches

Step 2 - Assessment, care planning and review

Step 3 - Co-ordination of care

Step 4 - Delivery of high quality services in different settings

Step 5 - Care in the last days of life

Step 6 - Care after death

2. Understand an individual's response 2.1 Evaluate models of loss and grief Evaluation of models of loss and grief: To include: Grief as a reaction to loss;



http://www.endoflifecare.nhs.uk/care-pathway/step-1-discussions-as-the-end-of-life-approaches.aspx

http://www.endoflifecare.nhs.uk/care-pathway/step-2-assessment,-care-planning-and-review.aspx

http://www.endoflifecare.nhs.uk/care-pathway/step-3-co-ordination-of-care.aspx

http://www.endoflifecare.nhs.uk/care-pathway/step-4-delivery-of-high-quality-services-in-different-settings.aspx

http://www.endoflifecare.nhs.uk/care-pathway/step-5-care-in-the-last-days-of-life.aspx

http://www.endoflifecare.nhs.uk/care-pathway/step-6-care-after-death.aspx



to their anticipated death range of feelings, thoughts, and behaviours; varies according to culture, background, gender, beliefs, personality, and relationship to the deceased; sadness, guilt, regret, anger, sense of lack of meaning or relief and freedom; Kubler-Ross - five stages of grief; denial, anger, bargaining, depression, and acceptance , Stroebe and Schut -dual process; experience of loss (sadness, anger, yearning, crying) and the experience of restoration (feeling “normal,” joy, contentment, laughing) , Worden- four Tasks of Grief: accept the reality of the loss, work through the pain of grief, adjust to life without the deceased , maintain a connection with the deceased but moving on.

2.2 Describe how to support the individual throughout each stage of grief

How to support the individual throughout each stage of grief: To include: acknowledgement of what has happened; expressing concern; offer of support; listening with compassion; offering practical assistance; warning signs of when to encourage the grieving person to seek professional help.

2.3 Explain the need to explore with each individual their own specific areas of concern as they face death

The need to explore with each individual their own specific areas of concern as they face death: To include: anxieties about how family and friends will cope with loss; will they be missed/remembered; loss of future plans.

2.4 Describe how an individual's awareness of spirituality may change as they approach end of life

How an individual's awareness of spirituality may change as they approach end of life; To include: re-examining and rekindling beliefs and observances.

3. Understand factors regarding communication for those involved in end of life care

3.1 Explain the principles of effective listening and information giving, including the importance of picking up on cues and non-verbal communication

Principles of effective listening and information giving: To include: enabling the accurate transfer of information, promoting mutual understanding, encourages reflection, questioning and strengthening of relationships; alertness for non-verbal clues; responding appropriately; know how to seek the support of others as necessary; promoting a sense of calm, time & safety; showing respect for individual’s feelings; promoting dignity; importance of listening; confidentiality.

3.2 Explain how personal experiences of death and dying may affect capacity to listen and respond appropriately

How personal experiences of death and dying may affect capacity to listen and respond appropriately: To include: personal and work experience, cultural or religious beliefs, literature, media - television or in films.

3.3 Give examples of internal and external coping strategies for individuals and others when facing death and dying

Examples of internal and external coping strategies for individuals and others when facing death and dying: To include: range of responses (psychological defences) which change with time. Classified as “open” or “closed”; dynamic (changing) model of coping responses; Denial/ Facing fears; Guilt/Fighting; Misery/ Adjusting; Helplessness/ Participation; Hopelessness/Seeking sense of purpose; coping strategy depends on attitudes, family experiences,



previous crises, level of support, current emotions and problems. Others may include:

Partner

Family

Friends

Care worker

Colleague

Manager

Social worker


GP


Physiotherapist

Pharmacist

Nurse

Psychologist

Independent mental capacity advocate


Clinical nurse specialist

3.4 Explain the importance of ensuring effective channels of communication are in place with others

The importance of ensuring effective channels of communication are in place with others: To include: helping patients to feel supported and valued; more likely to share fears and concerns with staff; improve patients’ emotional health, blood pressure, reducing pain and drug use; increase job satisfaction, reduces stress for staff; ensures needs of patients, families and carers are identified, responded to and met with respect and compassionate.

4. Understand how to support those involved in end of life care situations

4.1 Describe possible emotional effects on staff working in end of life care situations

Possible emotional effects on staff working in end of life care situations: To include: Awareness of loss and own losses, own mortality, anxiety, accumulating grief, own difficult or traumatic loss experiences, awareness of limitations of medicine, own limitations as caregivers, threats to feelings of self-control, mastery, self-esteem, disillusionment with the realities of death.

4.2 Evaluate possible sources of support for staff in end of life situations

Possible sources of support for staff in end of life situations: To include: friends and family, local carers groups, online forums, local branches of national services, other carers, GP, counselling services, local support groups, carers centres, local social services.



4.3 Identify areas in group care situations where others may need support in end of life care situations

Areas in group care situations where others may need support in end of life care situations: To include: recognising that a colleague is finding it difficult to cope with their caring role especially if they have suffered recent or traumatic losses themselves, have difficulties in personal life, the situation reminds them of their own experiences, they relate closely to the situation e.g. person dying is same age as them or someone close to them; they have experienced several end of life care scenarios in a short time ; they are overtired and not relaxing away from work or have too high a workload.

4.4 Outline sources of emotional support for others in end of life care situations

Sources of emotional support for others in end of life care situations: To include: friends, family, colleagues, manager, counselling services.

5. Understand how symptoms might be identified in end of life care

5.1 Identify a range of symptoms that may be related to an individual's condition, pre-existing conditions and treatment itself

Symptoms that may be related to an individual's condition, pre-existing conditions and treatment itself: To include: any hindrance to the wellbeing of an individual - not confined to medical symptoms: physical, emotional or psychological symptoms; maintaining comfort and wellbeing e.g:

Reduced tissue viability

Breathlessness

Loss of appetite

Fatigue

Anxiety

Sadness

Discomfort

5.2 Describe how symptoms can cause an individual and others distress and discomfort

How symptoms can cause an individual and others distress and discomfort: To include: pain, invasive treatments, side effects of medication and treatments, nausea.

5.3 Describe signs of approaching death Signs of approaching death: To include: profound weakness, requiring assistance with all activities, reduced consciousness, unable to take diet and fluids and will find swallowing medications difficult, reduced ability to cooperate with simple instructions, increasingly disorientated, noisy, respiratory secretions during the last 48 hours, shallow breathing and sometimes apnoea, pale, cool skin due to peripheral vascular shutdown, weak and thready pulse.

5.4 Identify different techniques for relieving symptoms Techniques for relieving symptoms: To include: painkillers, anti-emetics, physiotherapy - exercise and complementary therapy - massage or reflexology.



6. Understand advance care planning 6.1 Explain the difference between a care or support plan and an advance care plan

Differences between a care or support plan and an advance care plan: to include: Care plan: is advisory and provides the multidisciplinary team with a plan of action that covers any aspect of current care, written in discussion with the individual or completed for an individual who lacks capacity, plan for current and continuing care that contains achievable goals and the actions required. Advance care plan: Makes the multidisciplinary team aware of an individual’s wishes and preferences in the event that the patient loses capacity; covers any aspect of future health and social care; written by the individual possibly with support from professionals, and relatives or carers; covers an individual’s preferences, wishes, beliefs and values about future care to guide future best interests.

6.2 Identify where to find additional information about advance care planning

Where to find additional information about advance care planning: To include: legal status and implications of the Advance Care Planning process in accordance with the provisions of the Mental Capacity Act 2005. ‘Thinking Ahead’ – GSF Advance Care Planning Discussion; NHS End of Life Care Strategy.

6.3 Describe own role in advance care planning Own role in advance care planning: To include: discussing available options, providing information about services, encouraging individual to think about all aspects of care; liaising with other professionals.

6.4 Explain why, with their consent, it is important to pass on information about the individual's wishes, needs, and preferences for their end of life care

Why, with their consent, it is important to pass on information about the individual's wishes, needs, and preferences for their end of life care: To include: making sure that wishes, needs and preferences are met especially if individual is not able to communicate themselves; ensuring that inappropriate procedures are not carried out.




Delivery This unit develops the learner’s knowledge and .understanding of current approaches to end of life care, how individual's respond to their anticipated death, factors regarding communication for those involved in end of life care, how to support those involved in end of life care situations, how symptoms might be identified in end of life care and an understanding of advance care planning Assessment Assessment is by portfolio (internally set and marked and quality assured by IQ). An Achievement Record for this qualification is available from the website/ on request. All assessment criteria must be met and mapped and the location of the evidence must be indicated in the achievement record. All learning outcomes must be assessed using methods appropriate to the assessment of knowledge and understanding; these can be assessed by a variety of methods including:




Essay

Other This unit must be assessed in accordance with Skills for Care and Development's QCF Assessment Principles (located in Appendix A of the specification for this qualification). Links The unit links to Skills for Care and Skills for Health Common Core Competences and Principles for End of Life Care



Unit 3: Understand how to support individuals during the last days of life J/503/8137 Guided Learning Hours: Unit Level: Unit Credit: Total Unit Time:

28 3 3

30



1. Understand common features of support during the last days of life

1.1 Describe the common signs of approaching death Common signs of approaching death: To include: profound weakness, requiring assistance with all activities, reduced consciousness, unable to take diet and fluids and will find swallowing medications, reduced ability to cooperate with simple instructions, increasingly disorientated, noisy, respiratory secretions during the last 48 hours, shallow breathing and sometimes apnoea, pale, cool skin due to peripheral vascular shutdown, weak and thready pulse.

1.2 Define the circumstances when life-prolonging treatment can be stopped or withheld

Circumstances when life-prolonging treatment can be stopped or withheld: To include: Advance Care Plan includes refusal of treatment; refusal of patient to give consent; treatment would prolong the dying process or cause the patient unnecessary distress; treatment is ineffective; resource constraints.

1.3 Analyse the importance of any advance care plan in the last days of life

Importance of any advance care plan in the last days of life: To include: Makes the multidisciplinary team aware of an individual’s wishes and preferences in the event that the patient loses capacity; covers any aspect of future health and social care; covers an individual’s preferences, wishes, beliefs and values about future care to guide future best interests.

1.4 Identify the signs that death has occurred Signs that death has occurred: To include: Breathing has stopped; no heartbeat; loss of control of bowel or bladder; unresponsive to attempts to waken; eyelids slightly open; eyes fixed; jaw relaxed, mouth slightly open.

2. Understand the impact of the last days of life on the individual and others

2.1 Describe the possible psychological aspects of the dying phase for the individual and others

Possible psychological aspects of the dying phase for the individual and others: To include: worry, anxiety, panic, anger, resentment, sadness and depression, people become withdrawn; Others may include:



Partner

Family

Friends

Care worker

Manager

Social worker


GP


Physiotherapist

Pharmacist

Nurse

Psychologist

Independent mental health advocate


Clinical nurse specialist

2.2 Explain the impact of the last days of life on the relationships between individuals and others

Impact of the last days of life on the relationships between individuals and others: To include: difficult to talk to the people close to you, becoming withdrawn; anxiety, regret.

2.3 Outline possible changing needs of the individual during the last days of life

Possible changing needs of the individual during the last days of life: To include: changing symptoms, changes to medication, loss of interest in eating /no appetite, feelings of disorientation.

3. Know how to support individuals and others during the last days of life

3.1 Describe a range of ways to enhance an individual’s wellbeing during the last days of life

Ways to enhance an individual’s wellbeing during the last days of life: To include: maintain comfort and other environmental factors; non-medical interventions; equipment and aids; alternative therapies.

3.2 Explain the importance of working in partnership with key people to support the individual’s wellbeing during the last days of life

The importance of working in partnership with key people to support the individual’s wellbeing: To include: supporting spiritual well-being; reducing anxiety and stress; maintaining a relaxing, caring environment; ensuring wishes are adhered to; minimising distress; identifying who they would like with them at the time of their death; identify how death should be communicated; maintaining contact details; complying with preference for place of death as far as practicable.

3.3 Describe how to use an integrated care pathway How to use an integrated care pathway: To include: ICP aims to have:



according to agreed ways of working the right people, in the right order and place, doing the right thing at the right time with the right outcomes with the patient at the centre.

3.4 Define key information about the process following death that should be made available to appropriate people according to agreed ways of working

Key information about the process following death that should be made available to appropriate people: To include: Agreed ways of working include policies and procedures where these exist.

4. Understand the actions to be taken following an individual’s death

4.1 Explain national guidelines, local policies and procedures relating to care after death

National guidelines, local policies and procedures relating to care after death: To include: NICE development of and consultation on the end of life care Quality Standard; DH revision of the 2005 guidance When a Patient Dies; regulations on death certification process; local guidance regarding the criteria for verifying death; recording of verification of death, local policy regarding verification of death by nurses.

4.2 Explain the importance of being knowledgeable about an individual’s wishes for their after-death care

The importance of being knowledgeable about an individual’s wishes for their after-death care: To include: to ensure that individual's wishes are respected e.g. regarding funeral arrangements or organ donation; spiritual, cultural or practical wishes are implemented; to reduce distress caused to relatives and friends.

4.3 Explain the importance of acting in ways that respect the individual’s wishes immediately after death

The importance of acting in ways that respect the individual’s wishes immediately after death: To include: honouring the religious or cultural wishes/requirements of the deceased and their family while ensuring legal obligations are met.

4.4 Describe agreed ways of working relating to prevention and control of infection when caring for and transferring a deceased person

Agreed ways of working relating to prevention and control of infection when caring for and transferring a deceased person: To include: systems to manage and monitor the prevention and control of infection including risk assessments; standard infection control precautions during transfer; maintaining a clean and appropriate environment in managed premises which facilitates the prevention and control of infections; effective communication; implementing control measures; documentation; appropriate use of PPE, body bags etc. if person had an infectious disease.

4.5 Describe ways to support others immediately following the death of a close relative or friend

Ways to support others immediately following the death of a close relative or friend: To include: acknowledgement of situation, expressing concern, listening with compassion, allowing person to express their feelings, not being afraid to express own feelings, patience; offering practical assistance.



5. Know how to manage own feelings in relation to an individual’s dying or death

5.1 Define possible impact of an individual’s death on own feelings

Possible impact of an individual’s death on own feelings: To include: heightened sense of own mortality; anxiety; guilt for not being able to do more; sadness; sense of loss; empathy for person's family and friends.

5.2 Identify available support systems to manage own feelings in relation to an individual’s death

Support systems available to manage own feelings in relation to an individual’s death: To include: colleagues and friends, team members; specialists such as counsellors.




Delivery This unit develops the learner’s knowledge and understanding of common features of support during the last days of life, the impact of the last days of life on the individual and others, how to support individuals and others during the last days of life, the actions to be taken following an individual’s death and how to manage own feelings in relation to an individual’s dying or death. Assessment Assessment is by portfolio (internally set and marked and quality assured by IQ). An Achievement Record for this qualification is available from the website/ on request. All assessment criteria must be met and mapped and the location of the evidence must be indicated in the achievement record. All learning outcomes must be assessed using methods appropriate to the assessment of knowledge and understanding; these can be assessed by a variety of methods including:




Essay

Other This unit must be assessed in accordance with Skills for Care and Development's QCF Assessment Principles (located in Appendix A of the specification for this qualification). Links The unit links to Skills for Care and Skills for Health Common Core Competences and Principles for End of Life Care.



Appendix A

This Assessment Strategy was provided by Skills CFA to support delivery of qualifications on the Qualifications and Credit Framework (QCF). The QCF has now been replaced by the Regulated Qualifications Framework (RQF), however this Assessment Strategy is still relevant and must be followed. – (updated December 2017)

Skills for Care and Development QCF Assessment Principles 1. Introduction 1.1 Skills for Care and Development (SfC&D) is the UK sector skills council (SSC) for social care, children, early years and young people. Its structure for realising the SSC remit is via an alliance of six organisations: : Care Council for Wales, Children's Workforce Development Council, General Social Care Council, Northern Ireland Social Care Council, Scottish Social Services Council and Skills for Care. 1.2 This document sets out those principles and approaches to QCF unit/qualification assessment not already described in the Regulatory Arrangements for the Qualifications and Credit Framework. The information is intended to support the quality assurance processes of Awarding Organisations that offer qualifications in the Sector, and should be read alongside these. It should also be read alongside individual unit assessment requirements. Additional information/guidance regarding individual unit assessment can be obtained from Awarding Organisations, or from Skills for Care and Development. This must be used in order to provide the proper context for learning and assessment. 1.3 These principles will ensure a consistent approach to those elements of assessment which require further interpretation and definition, and support sector confidence in the new arrangements. 1.4 Where Skills for Care and Development qualifications are joint with Skills for Health, Skill for Health will also use these assessment principles. 2. Assessment Principles 2.1 Assessment decisions for competence based learning outcomes (e.g. those beginning with’ to be able to’) must be made in a real work environment by an occupationally competent assessor. Any knowledge evidence integral to these learning outcomes may be generated outside of the work environment but the final assessment decision must be within the real work environment. 2.2 Assessment decisions for competence based Learning Outcomes must be made by an assessor qualified to make assessment decisions. 2.3 Competence based assessment must include direct observation as the main source of evidence 2.4 Simulation may only be utilised as an assessment method for competence based Lo where this is specified in the assessment requirements of the unit’. 2.5 Expert witnesses can be used for direct observation where: they have occupational expertise for specialist areas or the observation is of a particularly sensitive nature. The use of expert witnesses should be determined and agreed by the assessor. 2.6 Assessment of knowledge based Learning Outcomes (e.g. those beginning with ‘know’ or ‘understand’) may take place in or outside of a real work environment. 2.7 Assessment decisions for knowledge based Learning Outcomes must be made by an occupationally knowledgeable assessor. 2.8 Assessment decisions for knowledge based Learning Outcomes must be made by an assessor qualified to make assessment decisions. Where assessment is electronic or undertaken according to a set grid, the assessment decisions are made by the person who has set the answers.



3. Internal Quality Assurance 3.1 Internal quality assurance is key to ensuring that the assessment of evidence for units is of a consistent and appropriate quality. Those carrying out internal quality assurance must be occupationally knowledgeable in the area they are assuring and be qualified to make quality assurance decisions. 4. Definitions 4.1 Occupationally competent: This means that each assessor must be capable of carrying out the full requirements within the competency units they are assessing. Being occupationally competent means they are also occupationally knowledgeable. This occupational competence should be maintained annually through clearly demonstrable continuing learning and professional development. 4.2 Occupationally knowledgeable: This means that each assessor should possess relevant knowledge and understanding, and be able to assess this in units designed to test specific knowledge and understanding, or in units where knowledge and understanding are components of competency. This occupational knowledge should be maintained annually through clearly demonstrable continuing learning and professional development. 4.3 Qualified to make assessment decisions: This means that each assessor must hold a qualification suitable to support the making of appropriate and consistent assessment decisions. Awarding Organisations will determine what will qualify those making assessment decisions according to the unit of competence under assessment. In any case of significant uncertainty the SSCs will be consulted. 4.4 Qualified to make quality assurance decisions: Awarding Organisations will determine what will qualify those undertaking internal quality assurance to make decisions about that quality assurance. 4.5 Expert witness: An expert witness must:

have a working knowledge of the QCF units on which their expertise is based

be occupationally competent in their area of expertise

have EITHER any qualification in assessment of workplace performance OR a professional work role which involves evaluating the everyday practice of staff



Resources

Training Resources

Centres may use their own, or published learner support materials in delivering the qualification. Whatever support materials centres choose to use, they should ensure that their delivery methodology adequately prepares the learner for assessment. IQ endorses published training resources and learner support materials by submitting the materials to a rigorous and robust quality assurance process, thus ensuring such materials are relevant, valid and appropriately support the qualification. Resources and Useful websites Health and Safety Executive www.hse.gov.uk The National Archives (For all UK legislation) http://www.legislation.gov.uk Equalities and Human Rights Commissions http://www.equalityhumanrights.com Health and Safety Executive for Northern Ireland http://www.hseni.gov.uk Equality Commission for Northern Ireland http://www.equalityni.org

Relevant parts of NHS Improving Quality http://www.endoflifecare.nhs.uk Skills for Care http://www.skillsforcare.org.uk/Home.aspx Skills for Care - End of Life Care http://www.skillsforcare.org.uk/Skills/End-of-life-care/End-of-life-care.aspx Skills for Care - learning materials http://www.skillsforcare.org.uk/Qualifications-and-Apprenticeships/Learning-materials/Learning-materials.aspx

http://www.hse.gov.uk/

http://www.legislation.gov.uk/

http://www.equalityhumanrights.com/

http://www.hseni.gov.uk/

http://www.equalityni.org/

http://www.endoflifecare.nhs.uk/

http://www.skillsforcare.org.uk/Home.aspx

http://www.skillsforcare.org.uk/Skills/End-of-life-care/End-of-life-care.aspx

http://www.skillsforcare.org.uk/Qualifications-and-Apprenticeships/Learning-materials/Learning-materials.aspx

Documents

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